1. Clinical Microsystems – an organisational development approach to service improvement
Laura Hibbs
Service Improvement Manager, NEYNL SHA
Diane Rothwell
Project Manager, NEYNL CHD Collaborative

2. Aims What is a clinical microsystem?
What is the microsystems model and how can it support you in your improvement work?
What can we learn from the experience of two of the national pilot sites?

3. What is a clinical microsystem?
A frontline team of patients, clinicians, managers, admin and information staff working together in an information rich environment to deliver and improve services to a defined population of patients

4. What is a clinical microsystem?
Community, Market, Social Policy System
Self-care System
Macro-organization System
Individual care-giver & patient System
Clinical Microsystem

5. …Echocardiography in Barnsley.
For example…
…Echocardiography in Barnsley.

6.  Secretary and Administrator Nurses Technicians Patients Information
system (new)
Health
Care
Assistant 
Receptionist
Information
system (old)
Doctors

7. Information system (modern)
Receptionist
Patients
Nurses
Information system (traditional)
Secretary and Administrator
Health Care Assistant
Technician
Doctor

8. Microsystems are the building blocks that come together to form larger organisations

9. What is the Microsystems Model?

10. The Microsystems Model
Three key components
The 4 P’s Framework
Tools and techniques
Teamwork

11. The 4 Ps P P P P
Patients Who are they? What do we need to know about them?
People the employees; How to involve them more? What do staff think?
Processes How do we run the things? What are our systems?
Patterns How do things vary? What causes variation?
…aiming to build a comprehensive understanding of the microsystem and how it works.

12. Clinical value compass
PLAN DO
STUDY
ACT
PDSA cycles
Variable 5 10 15 20 25 30 35 40
Date
Ounces
Run charts &
control charts
Generative
relationships
Flow charts &
deployment charts
Data & measures
Workforce
Development F C S
Clinical value compass
Global Aim
Template
Small groups
Task
Force
Team
Crew  
Fishbone
diagrams
Meeting
skills & disciplines

13. Summit Camp 3: “How can we all grow?” (11, 12)
Camp 2: “Do I belong here?” (7,8,9,10)
Camp 1: “What do I give? (3,4,5,6)
Basecamp: “What do I get” (1,2)

14. Data walls
(Swedish style)

15. (…and in the boardroom)
Data walls
(…and in the boardroom)

16. Microsystems resource pack
Introduction and survey materials
Colour coded for the 4 Ps
‘Starter pack’ for microsystem working
Materials developed by UK pilot sites
Adaptation and improvement continues!
Materials available as MS Word documents to change and adapt

17. “How to use…” - Four headings:
What is it?
“How to use…” - Four headings:
Why use it?
How to use it?
Notes and tips

18. Teamwork Team approach Shared vision, mission, information
Agreed priorities, improvement plans
Regular meetings, learning events
Regularly review and improve team climate
Learn simple improvement tools
Kaizen approach, PDSA cycles
Improvement tools/techniques
Review, reflect and plan together How are we doing? Where next?

19. How can it support you in your improvement work?
Cardiology Department
Barnsley District General Hospital
Blackburn Royal Infirmary
Clinical Measurement Department
Southern Derbyshire Acute Hospitals
Ilkeston Community Hospital
Erewash PCT
Neurological Outpatient Department
Hurstwood Park Hospital
Foxhall Day Surgery Unit
Ipswich Hospital
Cardiac Monitoring Unit
Hull Royal Infirmary
Riverside Surgery
North Lincolnshire PCT
How can it support you in your improvement work?

20. Wasting time in Ipswich

21. Evaluating microsystems in the NHS …some early comments from sites:
Liked the ability to adapt materials (e.g. tailor questionnaires) to differing settings
Have been selective in which surveys and questionnaires have been used
Gone at their own pace
Have variably used the 'tools’ - different bits found to be useful at different sites
Focus on staff views and issues has been popular

22. Evaluating microsystems in the NHS …some early comments from sites:
Took a while to get to grips with what microsystems working was and how to apply
Lot of things (too much?) fitted into the sessions
Pace of work - monthly sessions - has been ‘challenging’. Prompt or pressure?
Have used it to build on previous work
Hearing about each others’ experiences had been possibly the most useful aspect

23. Microsystem working…
Involves everyone (…the whole team, not just a ‘select few’)
Comprehensive and flexible (…not ‘problem focussed’ or highly prescribed)
Values staff views, experiences and welfare equally (…avoids improvement at staff expense)
Draws together different strands of improvement work (e.g. access improvement and workforce development)
Builds on any previous improvement projects (…provides somewhere to go after project ends)

24. Any Questions?

25. Key Contacts www.clinicalmicrosystem.org
Ian Golton, Modernisation Agency
Peter Wilcock, NHSU
Laura Hibbs, NEYNL SHA
Diane Rothwell, NEYNL CHD Collaborative